Advice on cataract surgery

Maddox,

I don’t think you are wrong about having to use sun glasses after having cataract surgery.

While ”Maggie” has pupils that operate, she was directed to wear sunglasses all the time outdoors on sunny days.

Cal
 
I had both eyes done in September 2017, one week apart. My cataracts were pretty advanced before the procedure. Couldn’t read highway signs or signs in an airport. My vision was like looking through a dirty window. I was also quite nearsighted and needed increasingly strong glasses correction for distance vision. It was past time to get the procedure done.

My opthamologist/eye surgeon is also an avid photographer. He recommended plain lens implants (no fancy coatings) so that my perception of color would not be affected. Long story short: results were and are fantastic. My vision is now 20/20 for distance. I only need glasses for reading and to correct for some astigmatism. Although I wear glasses more or less full time, I do not need them to focus a camera. I can take them off and focus just fine. I‘m still left-eye dominant, that didn’t change. But I enthusiastically recommend the procedure given the conditions you describe.
 
I had it done with a good outcome. As with many surgeries, infection is a risk. Religiously follow the post-op eye drop regimen; avoid dusty environments, and when the eyes have settled, buy a quality pair of sunglasses. Cheers, OtL
 
I had my cataracts removed some years ago, two years apart as they had progressed differently. In the pre-op waiting area I was guided to a comfy lounge chair and aides brought a pastry and eye drops, all done very calmly without haste. There were about eight operating booths and the doctor went down the row, taking about 15 minutes to do the operation on each patient. The uncomfortable part was the sticky patch that held my eyelid wide open during the procedure. Pupils were not removed, just the lenses were replaced with the new artificial ones. Very small incision at the edge of the iris. Then I was guided back to the same lounge chair for post-op recovery. At that time I recall looking at a large clock high on the wall that had a white face, and switching eyes to compare the difference... The eye that still had the cataract showed the clock face distinctly yellow-brown vs white with the other eye. I had gotten used to the tint and interpreted it as white. The plan was to set up the new lenses so that one focused nearer and the other at distance, and that has worked well. I was able to pass the drivers license renewal eye test without glasses for the first time, but for night driving I see better with my glasses on.

For the second cataract, two years after the first, I inquired at the veteran's hospital, thinking of saving the cost. That was disappointing, as their doctor said it wasn't bad enough yet for them to take on the job. Well, it was bad enough that if I closed the good eye, vision through the cataract was pretty bad for driving, if the need arose. Too risky to wait longer, I thought, and went back to my previous expensive doctor for that second cataract. No insurance coverage for this.

As a nice ego boost, I noted one of the professional certificates displayed on the doctor's office wall was printed with a typeface I had created.
 
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MarkWalberg said:
The comment about how whites went from a bit yellow/brown back to white is interesting.
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MarkWalberg said:
Mark, I had both eyes done several (8?) years ago. The only change I recall is the brown/yellow to white. It was a dramatic one, so much so I had to reprint several older prints which now were too cool.
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If things are now brighter, what is it like driving in traffic at night?

Being that people where I live drive with super-intense high beams on, both day and night, and even retro-fit their 30-year old POS with such lights, I can imagine what kind hell it is for people with cataract surgery to deal with being in traffic.

I have normal but nearsighted vision and it is maddening to have all these bright lights all the time. It should be illegal but it is not. Because money.
 
ranger9 said:
I was reluctant to have both eyes done at the same time, so had one about 18 months ago and the other last October. A few thoughts:

  • The surgery itself is basically a breeze. Tip: Book the earliest appointment you can get on surgery day. Why: You're not allowed to eat or drink before the surgery (rules vary; I was told nothing after midnight) so if you are scheduled for later in the day, you will be miserably hungry and thirsty by "go" time. If you get an early appointment, you won't have as long to be miserable!

  • Choice of your intraocular lens is a big deal and you should make sure the surgeon doesn't just brush it off when you go in for your pre-surgery consultation. The biggest choice is what distance range you want for your correction (this isn't super-exact; they only recognize four categories: close, reading distance, middle distance, and distant.) The surgeon told me that for men, usually they use a distant-vision IOL without even asking the patient, because "most guys want to be able to play golf without wearing glasses." At that point I put up my hand and said whoa: I told the surgeon I had been wearing glasses for distance vision since I was six and don't mind continuing to do so; I'd rather be able to read or use a computer without having to wear glasses. (So he set me up with a "grandma" prescription; he said a lot of older ladies having cataract surgery want to be able to read or do needlework without glasses, so they get a reading-distance IOL.) Incidentally, this is how I lucked into my Canon RF result, although I would not recommend choosing your IOL based solely on what will work best with your favorite camera. Still, it might not hurt to tell the surgeon you're a photographer and want to be able to use a camera comfortably.

  • Another IOL consideration: If you have any significant amount of astigmatism (ask the eye doc, or look for a big number in the "spherocylindric" section of your prescription) you will still need to wear glasses for perfect vision even at the target distance for your IOL. How big a nuisance this is depends on your amount of astigmatism and your tolerance. Personally, I have a fairly large amount of astigmatism, but can still see well enough to read or use a computer (or a Canon P) without needing to wear glasses, but I need them if I want to enjoy stage shows or read the street signs while driving. Suggestion: Give your vision a month or so to settle down after surgery and then get a refraction done to see what you need (and don't be afraid to pester them so they don't just rush through it.)

  • There are IOLs that are advertised as correcting astigmatism, and others that are advertised as covering multiple distance ranges. I immediately ruled those out because besides reading, stage shows, and photography, my favorite thing to do is driving, and I like driving at night. The special IOLs have multiple curvatures that can cause double images and flaring when looking at light sources at night, so no-go for me.

  • The glasses you end up with after surgery play a big role in your overall satisfaction. It took me four months and three tries to get the opticians to fix me up with glasses that were actually right. They'll probably recommend "progressive" lenses (aka no-line bifocals) set up to correct whatever distances your IOL doesn't cover, plus whatever astigmatism correction you need. This is usually a pretty good compromise, but if you've never worn progressives before, be aware that they take getting used to (there's only a small zone appropriate for each viewing distance, so you have to learn to point your nose at what you want to look at and then raise/lower your chin until it's in focus.) They also make it harder to use many kinds of cameras. I got a pair, but what I wear most of the time is single-vision lenses set up for distance vision plus astigmatism correction. My IOL lets me see well enough without glasses to get by at reading and middle distances, while the single-vision glasses let me enjoy a full field of sharp vision while driving or watching a show.
Key points: Don't let anyone rush you into anything, and don't feel embarrassed about insisting that people listen to what you want and do their best to deliver it. You really don't want to need a do-over on your cataract surgery!
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Ranger 9's answer was so thorough and so close to my own experience and conclusions I want to encourage others to look it over. To start with, I agree that the tri-focal lenses should be considered carefully before getting them, for exactly the reason ranger9 gave: the flare/glare problem when driving at night. I avoided them for that reason, and I'm glad I did. I opted for a milder degree of nearsightedness than I had always had. This resulted in a prescription change from a fairly strong minus 4 1/2 to a moderate minus 2 3/4. I was thrilled with that! I can see well enough for many things without wearing my glasses; can still read and see the computer without them; can photograph without them by using corrective diopter lenses on the cameras, and I can look out and see what I am photographing, often well enough without them.

My milder prescription now makes it possible to use lower diopter corrective lenses on the viewfinders, and they are easier to find than the stronger ones.

The surgeon waited a couple for weeks after doing the first eye, before doing the second one. You don't see so hot for a few days after surgery, in the eye that was treated; so as not to be functionally blind for a week or so, they do one eye at a time. Even so, they won't do the surgery unless you have a driver to take you home.

One thing ranger9 cautions about, is not much of a problem for me. I did opt for progressive lenses, and I'm glad I did. It took me no time at all to get used to adjusting my head angle to find the point of focus! And I mean no time! It is just the same as turning the focus ring on an SLR to get the sharpest image. For me, it was automatic! One and done. Note that I did say it was "not much of a problem." I didn't say it was no problem. The bottom of the lens where the focus is closest, isn't quite close enough for comfort in my case. So, I just take them off to read. It's not enough to make me go back to tri-focals.

When my Optometrist set me up for the surgery, she made sure to arrange for me to see the surgeon she knew was best for the procedure I needed. I believe that was a good thing. I'll end by suggesting that if you can get some info or guidance on which doctor to use, it will probably by worth doing, even if you have to wait longer.

I've very pleased with my results. I wish you the same!
 
Oh, yeah: One drawback to having a mild eyeglass proscription. I can see just fine around the house and around the office without my glasses. So I go without them. Then when it's time to leave the house or the office and drive, it's always, "Where did I leave my glasses?"
 
Calzone said:
I’m 65 and it seems my need for surgery likely will be way off in the future, but “Maggie” my partner at the age of 69 had one eye done and then the another.

In her case she got lenses that corrected a bad astigmatism, but the possibility of needing reading glasses became a reality.

Her eye pressure got high, and an eye drop was prescribed, and a side effect was “dry-mouth” that for her became a serious condition that luckily subsided. It was uncomfortable.

Cal
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Before my surgery, I had to use drops for high eye pressure. But during the surgery, the doctor used a laser to punch little drain holes in the back of my eyes. Now my eye pressure is normal and I don't need the drops. This is a good thing to ask about!
 
Original poster here.
Getting ready to see the doc Monday about getting the cataract surgery.
I've been reading about the lens types.
It is interesting to learn about the different ways they get more distances in focus without glasses.

The older way is to make lenses with alternating rings of two or three different focal lengths. This would place an in focus image (from one of the focal lengths) superimposed on an out of focus image (from the other focal length) on the retina. I guess the brain gets good at paying attention to the sharper image. I'd guess that resolution suffers a little from this. This is the type most likely to give halos at night, thought to be from the edges between the rings.

The other way of doing it is called Extended Depth of Focus (EDOF). This is done by making a lens with more spherical aberration. This makes the depth of focus at the retina deeper because different parts of the lens are in focus at different depths. Again, this would superimpose a sharp image with less sharp images. And, again, I think that this would make resolution a bit lower. The advantage of this one is that there are no edges from alternating rings, making less halos at night

I haven't figured out whether the reduced resolution from either of these makes any difference in daily visual life. If the reduction is significant, then it might be better to get the single vision lenses for distance, and wear glasses for closer work.

Too bad one can't try them on in advance. Hopefully, the doc will give me some insight on these.
 
Do you suppose they could put the multifocal lens in one eye, and a standard one in the other? They do something similar when they use a technique called "monovision," which involves wearing a contact lens in one eye, say for distant vision, and going au naturel with the other eye, which takes over the close-distance duties. So in this application, you might wear a conventional lens, corrected for distance, in one eye, and the multifocal lens in the other. The idea would be that when you need the sharpest possible vision, say for driving, you just close the multifocal eye for a moment when the view is too blurry, or there is flare from oncoming headlights. You don't need or use binocular vision to judge distance beyond 20 or more feet anyway--our perceptual psychology prof. in grad school taught us that. So it might work. Any volunteers?
 
That idea of a multifocal lens in one eye and mono in the other is worth thinking about. THanks for the idea. I'll ask the doc.

It seems that one of the effects of the multifocal or EDOF lenses woud be to reduce contrast. I think this because a significant portion of total light would not be part of the sharply focused image, thereby adding nonimage forming light elsewhere on the retina. I think I'll read some more of Ray and Kingslake to lear more about what spherical aberration does to the image in a camera.
 
I might be also a candidate for such a surgery in the next couple of years. Thanks to all for sharing your experience.
Rob-F said:
Do you suppose they could put the multifocal lens in one eye, and a standard one in the other? They do something similar when they use a technique called "monovision," which involves wearing a contact lens in one eye, say for distant vision, and going au naturel with the other eye, which takes over the close-distance duties. So in this application, you might wear a conventional lens, corrected for distance, in one eye, and the multifocal lens in the other.
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This is what I do nowadays for planned photo sessions. My left eye is the better one and I wear a contact lens for distant vision on it (see the facial expression of distant people). I keep the right one free from any helpers, as it is my more myopic eye. I switch to it for camera controls and other near field activities.
RIght-eye designed OVF cameras help a lot to apply this two-sighted technique during shooting.
 
My results were both good and disappointing. I can now drive at night, something I'd almost given up as my vision was awful with oncoming lights. Vision is much brighter now. So the main reasons for having the ops. were solved.
But to save costs I had single vision lenses, for distance only. That means when using a camera I need reading specs to make some adjustments and as I still need distance specs swop back to them to focus and frame the picture. I suggest if you can afford the lenses which give both distance and close vision, go for it. I don't regret having my eyes done but it wasn't the cure all I thought it would be.
 
Mark,

“Maggie” who will turn 70 soon paid a lot for upgraded lenses that were not paid for by Medicare. Pretty much out of pocket like $8K. She had very poor vision, PhD, and was a college professor… Basically a nerd. LOL.

Only bad thing was that she needs reading glasses.

The dry mouth she got from a pressure reducing drug side effect is fading, but still there.

I would not cheap-out on my eyes.

Cal
 
Doug said:
......... The eye that still had the cataract showed the clock face distinctly yellow-brown vs white with the other eye. I had gotten used to the tint and interpreted it as white. .........
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Original poster here. Well, I had the right eye done yesterday. It was easy. Like Doug, I was surprised and amazed to see how white things are now. I thought I could see white before the new lens. Now, when I can compare a new clear lens to the old brown lens, the difference is remarkable and very enjoyable. Next eye in 2 weeks.

I got a lens called J&J Eyehance toric. This is mostly a monovision lens that also corrects my astigmatism. It has a small amount of change of power comparing center of lens to edge. (Sort of a little spherical aberation, but it is aspherical.) This improves focus down to medium distance, defined as 2/3 of a meter away. So, now, distance vision in that eye is crisp and clear in the distance. I can read the paper, the computer screen or a book without glasses, but reading glasses help a bit. Anything closer (such as repairing cameras and lenses) needs higher power reading glasses. I've worn glasses every day for 40 years. Now, I won't have to wear them most of the time. I'm sure I'll start losing them here and there, but reading glasses are cheap. The return of great detail in the distant vision is truly wonderful. The only bad part is the cost, which seems to be working out to about $3500 per eye, after Blue Cross. All the advice in this thread was very helpful. Thanks to everyone.
 
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